Dec. 21, 2000 (Washington) -- Now that George W. Bush is getting established as president-elect, the talk of the town is the high-level health executive appointments he must make to build his administration.
The biggest health post is the cabinet-level Secretary of Health and Human Services and GOP Wisconsin Gov. Tommy Thompson appears to be the leading candidate. He met with Bush in Washington on Tuesday and later told the Associated Press that he is considering a cabinet post. Bush may announce the HHS secretary as early as Friday.
Thompson, 59, is the nation's longest-serving governor; he's has been Wisconsin's chief executive since 1986. A lawyer, he began his career in the Wisconsin State Assembly in 1966.
A health-specific resume is hardly a prerequisite for the HHS post. Donna Shalala, who has served as HHS secretary for Clinton, had been president of the University of Wisconsin, and will leave the administration to head the University of Miami.
Thompson isn't known as a health policy guru, but is credited with welfare-to-work reforms and education initiatives during his tenure as governor. Those may be key credentials to a Bush administration interested in "devolving" power to state programs.
But Thompson has been responsible for several healthcare initiatives in Wisconsin. He launched BadgerCare, the state's program of health insurance for low-income working families, and Family Care, a long-term managed care program for low-income elderly and the disabled.
Thompson's extensive state-level experience, and his leadership background at the National Governors Association, also might be useful as Bush tries to move a Medicare prescription drug plan that would rely on significant state-level control.
The choice of Thompson would satisfy a Republican conservative "litmus test", since he opposes abortion. Wisconsin enacted a partial-birth abortion ban during his governorship.
Thompson unsuccessfully sued Clinton's HHS over its proposal to revamp the nation's system of organ allocation. Wisconsin has had high rates of organ donation, and Thompson worried that the new system would threaten its success, by switching from regional distribution to a nationwide scheme based on medical need. A revised version of the original HHS proposal is now in place.
Two other key names in circulation for the HHS job lack Thompson's mass appeal, but have impressive Washington experience in health policy.
Gail Wilensky, PhD, current chair of the congressional Medicare Payment Advisory Commission, ran the Health Care Financing Administration -- HCFA -- from 1990 to 1992 for the administration of Bush Sr. And William Roper, MD, dean of the school of public health at the University of North Carolina at Chapel Hill, served from 1990 to 1993 as Bush Sr.'s head of the CDC. Roper also ran the Reagan HCFA from 1986 to 1989.
Both Wilensky and Roper were health advisers to George W. Bush in his recent bid for the White House.
Other names that have surfaced in the rumor mill areRep.Tom Coburn, MD, (R-Okla.), an ardent abortion opponent who is retiring from Congress; Kay James, a former Virginia health secretary and past executive of the conservative Family Research Council; Rep. Rick Lazio (R-N.Y.), who just lost a Senate bid to Hillary Clinton; and Robert Woodson, a social activist who has long backed welfare reforms.
Meanwhile, Bush's inauguration is just a month away. Anthony Mazzaschi, a Washington official with the Association of American Medical Colleges, tells WebMD, "Most administrations would have announced HHS by now, although I don't think that past experience is a good indicator given this year." Indeed, this year's strange post-election chaos didn't give Bush the White House until earlier this month.
There is a host of other key health appointments that Bush must make, from HCFA administrator to FDA commissioner and director of the National Institutes of Health. He is also likely to name a new Surgeon General and CDC director. Who he names to these appointments will send a message on the likely slant of the policies that Bush will take on the health questions those offices must address.
Tom Scully, a Bush supporter and President of the Federation of American Hospitals, tells WebMD that these picks may take a while. "They've got to get to the Cabinet appointments, and it will be, in many cases, months," he says.
Nevertheless, there is no shortage of speculation about who might lead the various agencies. If the next NIH director, for example, comes from the inside, conventional wisdom holds that several of the institute's directors are likely choices: Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases; Richard Klausner, MD, director of the National Cancer Institute; and Francis Collins, MD, director of the National Human Genome Research Institute.
The NIH's support of basic biomedical research has made it a Republican budget favorite, but it may face other challenges next year.
Bush's anti-abortion stance could make for controversy at the NIH, which decided under Clinton that it will federally fund some research on stem cells derived from human embryos. The stem cells hold dazzling promise for treating a wide range of dreaded diseases, but some hold that taking cells from embryos is essentially murder.
According to Mazzaschi, "If they make a determination that they're going to try to stop stem cell research, they have to find somebody who's willing to come in and do that, and frankly I think you'd find very few prominent scientists who are willing."
"I don't know that there is a resolution," says Myron Genel, MD, a dean at Yale University School of Medicine. "This issue is so deeply felt and [those with opposing views] are so polarized."
Many business and healthcare provider interest groups are optimistic that the Bush administration will be less regulatory than that of Bill Clinton. According to Neil Trautwein, lobbyist for the National Association of Manufacturers, "We'll be able to constructively and cooperatively engage the Bush administration. But there are no slam dunks with the Congress this close and the issues so diverse."
Scully tells WebMD that he expects Bush to seek a quick resolution on a managed care "patients' bill of rights." He says, "If they were trying to clear the decks politically and get off to a good start, one of the things they might look at right after education would be finding a way to cut a deal on patients' bill of rights. It would be a good victory right off the bat."